Coronary risk factors and inflammation in patients with coronary artery disease and internal cardioverter defibrillator implants

Background The internal cardioverter defibrillator (ICD) is increasingly used to treat ventricular tachyarrhythmias in patients with coronary artery disease (CAD). The burden of coronary risk factors and inflammation is however not well studied in these high risk patients. Study aims The aim of the present study was to describe the prevalence of coronary risk factors (including lipid values) and inflammation (including high sensitive-C-reactive protein, hs-CRP) in patients with CAD and ICD implants. Methods Baseline clinical characteristics and laboratory results of all eligible patients for the Cholesterol Lowering and Arrhythmias Recurrences after Internal Defibrillator Implantation trial (CLARIDI trial) were used. All patients had documented CAD, an ICD implant and were not yet treated with statins. Coronary risk factors, lipid values, glycated haemoglobin (HbA1c) and hs-CRP levels were determined. Results In the 110 included patients (mean age 68 ± 9 years, LVEF 40 ± 17%, NYHA class II–III in 47%), a high prevalence of coronary risk factors was documented: current smoking in 18%, body mass index ≥ 30 kg/m2 in 16%, blood pressure ≥ 140 / 90 mm Hg in 40%, history of diabetes in 12%, and HbA1c ≥ 6% in 16% of patients not known with diabetes. A total cholesterol > 175 mg/dl was found in 76% of patients and an LDL cholesterol > 100 mg/dl in 83%. Finally, median hs-CRP was 4.8 mg/l (interquartile range 2.5–13.9 mg/l). Hs-CRP values ≥ 2 mg/l were noted in 83% of all patients and in 68% of patients who had an ICD implant more than 6 months before inclusion. Conclusion In CAD patients with ICD implants, the burden of coronary risk factors is high, often unrecognized and/or under-treated. Persistent inflammation is found in the majority of these patients.